Analyst, Healthcare Compliance
Microsoft 365
Provider Engagement Lead, Risk Adjustment
Alignment Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $65,865 - $98,798 per year
Job Level
Senior
About the role
- Validate provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records.
- Develop education materials to assist physicians in accurately assessing patients’ overall health status.
- Provide feedback to providers on performance improvement opportunities; track and prioritize projects to improve coding and documentation outcomes.
- Maintain a comprehensive tracking and management tool for assigned physicians within Alignment Healthcare provider network.
- Identify issues, determine impact to risk adjustment models, and report results timely to ensure physician compliance.
- Collect, analyze, and share MRA performance data through presentations and detailed reports, including outreach priorities, HCC gap data, and encounter status insights for Joint Working Groups.
- Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures.
- Present progress and results to leadership routinely.
- Assist with CMS Risk Adjustment Data Validation activities to prepare for and pass audits.
- Regularly update Risk Adjustment materials with clinical and guideline changes and suggest enhancements to clinical educational materials.
- Provide onsite education and outreach to external physicians and clinical staff.
Requirements
- Three-five years of coding in a medical group or health plan setting required; Professional Coding experience required.
- Experience with strategic planning in risk mitigation.
- Proficiency in MS Officer suite including Access (preferred).
- Previous use of Epic, Allscripts, EZCap a plus (preferred).
- Bachelor’s degree in business administration, health care management or a related field or equivalent experience.
- Current driver’s license.
- Preferred: Nursing degree.
- Required certifications: CPC, CPC-H, CCS, CCS-P, RHIT, RHIA, OR CPMA.
- Ability to utilize, protect, and disclose Alignment Healthcare patients’ protected health information (PHI) only in accordance with HIPAA standards.
- Local travel is required.
